More on The Continuing Proof of the Efficacy of Anti-Psychotics

The narratives from the proponents of Open Dialogue remind me of the narratives arising from the psychoanalysts working in private psychiatric hospitals in the United States in the 1950’s and 1960’s. Many case studies were available and even books written on the subject.

In the late 1960’s we were unlocking the doors of the mental hospital in Vancouver and applying therapeutic community principles. The principles and ideas of the therapeutic community can be found in the activities of the Open Dialogue program. And before that they can be found in the practices of small hospitals from the Moral Treatment Era of the 1850’s to 1890’s, and again, briefly, in some mental hospital reforms shortly after WW1 and before the Great Depression, albeit, in each case, within the language and pervasive philosophies of the time.

In the late 1960’s we had already discovered how wonderfully effective chlorpromazine could be in containing mania and reducing the psychotic symptoms of schizophrenia.

So in this context, knowing the evidence, the clear evidence of chlorpromazine being the first and only actually effective treatment for psychosis, and lithium for mania (beyond containment, sedation, shelter, kindness, protection, food, routine grounding activities, time and care) it behooved us to look closely at the claims of the psychotherapists who were writing such elegant and positive case studies from the American private hospitals.

So I read them.

They were interesting reading, detailing the relationship of therapist and psychotic patient, interpreting the content of the psychosis, and the painstaking time consuming process of building a relationship, working to help the patient view the world in a different manner, and always, through the pages of these reports, it was said great progress was being made. And they all ended with something like (this is the one I remember best) “Unfortunately, despite showing so much progress, patient X assaulted a nurse and had to be transferred to the State facility.” Curiously, as with many “studies” I read today, despite the obviously bad outcome, a paragraph is added at the end extolling the progress made (before the unfortunate outcome) and recommending we stay the course.

There are many interesting explanations for the continuing anti-medication (for mental illness) philosophies. (Note that almost nobody objects to taking medication for other kinds of suffering and illness). Marvin and I have written about a few – the preciousness of the sense of self, the wish that there be an immortal mind that can outlive a brain, the fear of being controlled, distrust of Big Pharma, professional jealousies, and turf wars. But writing the above reminds me of another reason this irrationality persists.

It was clearer to me then (1960’s/1970’s) than it is now, because we really wanted to find ways of helping without medication: It is much more ego gratifying to mental health workers of all stripes when our patients get better simply because of our presence, our words, our care, ourselves, than if we just happen to prescribe the right medication.

I remember well a patient, a professional, a few years ago, thanking me for helping him overcome a severe depression. “Nah,” I said, “I just managed to prescribe the right medication for you.” “No, no,” he said. “It was more than that.”

All right. There are a few moments when I can be attentive, thoughtful, kind, and even find the right words. But to try doing that alone while withholding medication for severe mental illness would be malpractice, cruel, egotistical, even sadistic.

5 thoughts on “More on The Continuing Proof of the Efficacy of Anti-Psychotics”

All right. There are a few moments when I can be attentive, thoughtful, kind, and even find the right words. But to try doing that alone while withholding medication for severe mental illness would be malpractice, cruel, egotistical, even sadistic.
I have long argued this point . Imagine not prescribing insulin for Diabetes Type 1 . The big pharma antics are one thing but essential treatments are another ! Thank you

Good article. I would mention more reasons my peers sometimes reject medication. One is side effects and another is very bad experiences on what turned out to be inappropriate medication. For instance, I know of an instance where an antidepressant given to a wrongly diagnosed person with bipolar resulted in psychosis and a tragedy. Another friend reports having suicidal thoughts on I believe it was an anti psychotic. That being said, the right medication is often a live saver.

Why is that so many discussions come down to either/or? Do you breathe in or breathe out? Which is it now? Don’t be wishie washie.

It only makes natural sense, especially in real major mental illnesses (not the absurd expanse of problems that are called ‘mental illness’ today) that medication AND a therapeutic relationship are better than either alone–both/and! So yes, it is more than hitting on the right antidepressant. It is also the therapeutic interaction. Care.

Don’t underrate the power of insight. Very often, even in serious psychiatric disorders, insight can replace medications. I am inclined, in many cases to see medication as a highly valuable symptomatic remedy that prevents disability, while insight turns out to be the cure.

Our brains are organizing machines. They need explanations. Without explanations our anxiety runs high; we seek and we repeat. A satisfying and satisfactory explanation for our behaviours, our unwellness, our compulsions and our anomie is always welcome. Well, not always welcome, if it entails some truth we would rather avoid.
But does it matter what that explanation is? Be it universal truth, peculiar psychological verities, social imperatives, evolutionary necessities, or the word of God?
But, I’ll give you this, Howard, while we seek these insights it is always good to have a non-judgmental, sure-footed companion at our side.